Comparative fine‐needle aspiration and pathologic study of malignant fibrous histiocytoma: Cytodiagnostic features of 95 tumors in 71 patients

Abstract

To determine diagnostic cytomorphologic features of malignant fibrous histiocytoma (MFH) on fine-needle aspiration (FNA) materials, we reviewed the cytologic material and corresponding histologic slides of 95 tumors in 71 patients. Forty-four (46%) tumors were primary, 38 (40%) were recurrent, and 13 (14%) were metastatic. Histological variants of MFH were as follows: 52 (54.7%, 43 patients) were of the storiform/pleomorphic, seven (7.4%, five patients) were giant cells, four (4.2%, four patients) were inflammatory, and 31 (33.7%, 19 patients) were myxoid type. Review of original cytology reports showed that only 23 (24.2%) tumors were diagnosed as MFH and 68 (71.6%) as other types of malignancies. Four (4.2%) cases were reported as unsatisfactory/suspicious. Our findings showed that spindle-shaped, round, giant cells, osteoclastic-like giant, and inflammatory cells were the most consistent features that allow identification of the storiform/pleomorphic, giant cell, and inflammatory variants of MFH. The myxoid tumors had marked myxoid background matrix with spindle-shaped cells and, less frequently, round and giant cells. Pleomorphic leiomyosarcoma and dedifferentiated liposarcoma should be considered in the differential diagnosis of stroriphorm/pleomorphic, giant cells, and inflammatory variants of MFH. However, myxoid MFH may resemble their leiomyosarcoma and liposarcoma counterparts.

Malignant Fibrous Histiocytoma of the Chest Wall Masquerading as Medullary Breast Carcinoma

“…Erroneous diagnoses in the breast and chest wall region have included metaplastic carcinoma, malignant phylloides tumor, poorly differentiated carcinoma, spindle cell squamous carcinoma, lymphoma, inflammatory pseudotumor, and various other benign and malignant soft tissue tumors. 2,[7][8][9] The cytologic misdiagnosis in the present case was due partly to overreliance on the clinicoradiologic evidence of the tissue of origin, creating a high index of suspicion for a breast tumor. It was also caused by the variable tumor morphology in different areas and the possibly resultant selective sampling.…”

“…It shows a predilection for the deep, soft tissues of the extremities and may also arise in the abdominal cavity and retroperitoneum. 2,3 Primary MFH of the thoracic wall is unusual and commonly manifests as a large, heterogeneous mass with osseous involvement. Lymph node spread is infrequent in this recurrence-prone mesenchymal tumor.…”

Fine‐needle aspiration in liposarcoma: Cytohistologic correlative study including well‐differentiated, myxoid, and pleomorphic variants

“…Smears of intramuscular myxomas are of low cellularity in a myxoid background; spindle to stellate cells do not show any cytologic atypia. Although lipoblasts are absent, 18,22 the occurrence of collection of macrophages with intracellular droplets of lipid and/or mucin material could lead to confusion. Cytologic features in myxoid chondrosarcoma are quite distinct, at least in the more solid areas of the tumors.…”

“…Dedifferentiated LS without lipoblasts or pleomorphic LS on cytology smears may be misdiagnosed as other high-grade sarcoma, especially pleomorphic malignant fibrous histiocytoma. 22 Myxoid sarcomas present the greatest challenge in an attempt to make a diagnosis with cytologic methods. 10,12 Tumors that have a prominent myxoid component on FNA include myxoma, myxoid chondrosarcoma, chordoma, myxoid leiomyosarcoma, and myxoid malignant fibrous histiocytoma.…”

Fine‐needle aspiration of primary and recurrent benign fibrous histiocytoma: Classic, aneurysmal, and myxoid variants

“…Cellular fascicles, stromal fragments, and, occasionally, myxoid background may be seen. 11 The smears in dermatofibrosarcoma protuberans (DFSP) are composed of isolated spindle cells, connective fragments with storiform, and/or fibrillary pattern and naked nuclei. Giant cells, or marked cytonuclear atypia are exceptional.…”